Can You Mix Caffeine and Antidepressants or Anti-Anxiety Medications?

Prescription medication can be essential for some people living with depression, anxiety or another mental health condition. But can you mix sources of caffeine — like coffee or energy drinks — and antidepressants or anti-anxiety meds?

"With modest doses of caffeine, most people don't experience any difficulty with their antidepressants," says Timothy B. Sullivan, MD, psychiatrist and chair of Psychiatry and Behavioral Sciences at Northwell Health's Staten Island University Hospital in New York City. "So if you're on antidepressants and drinking one or two cups of coffee a day, I don't typically recommend cutting back."

This holds true for people taking the most commonly prescribed class of mental health medication, called selective serotonin reuptake inhibitors, or SSRIs, Dr. Sullivan says. According to the Mayo Clinic, SSRIs include drugs like:

• Prozac (fluoxetine)
• Celexa (citalopram)
• Lexapro (escitalopram)
• Zoloft (sertraline)
• Luvox (fluvoxamine)
  

It's important to note, however, that a high caffeine intake — more than a couple of cups of coffee a day — when taking any antidepressant or anti-anxiety med can increase your risk of a problem in general.

And according to a September 2015 study in ‌BJPsych Advances‌, people with mental illnesses tend to get more caffeine to begin with, and having depression or anxiety can make you more sensitive to its jittery effects.

The authors of the study note that combining lots of caffeine with any serotonergic medication raises the risk for a potentially life-threatening situation called serotonin syndrome.

This is when too much serotonin floods your brain at once, according to the U.S. National Library of Medicine (NLM). (It can also happen if you take an SSRI and a triptan, a migraine medication, at the same time.) And this serotonin and caffeine interaction can prompt anxiety, confusion, insomnia, restlessness, tremors and muscle problems.

To avoid this and any other potential side effects, here's an overview how caffeine and antidepressants or anti-anxiety meds mix, broken down by the type of medication.

Caffeine does affect some antidepressants — there's concern about one SSRI in particular, Luvox (fluvoxamine), which is primarily used to treat an anxiety disorder called obsessive-compulsive disorder, or OCD.

It has to do with Luvox's effect on a caffeine-metabolizing enzyme called CYP1A2, says Laura J. Fochtmann, MD, MBI, professor in the departments of Psychiatry, Pharmacological Sciences and Biomedical Informatics with the School of Medicine at Stony Brook University in Stony Brook, New York, and a medical editor with the American Psychiatric Association.

Luvox cuts caffeine metabolism by upwards of 80 percent, according to the ‌BJPsych Advances‌ research‌,‌ so more caffeine stays in your system. That can send both medication and caffeine levels out of whack, Dr. Fochtmann says.

The result is "a significant risk for jitteriness, wakefulness, a rapid heartbeat, insomnia and high blood pressure," Dr. Sullivan says.

However, "Fluvoxamine was used a lot before Prozac came along, but it has a lot more side effects, so it's not used as often nowadays," he says.

Zoloft (sertraline) is an SSRI used to treat depression, along with OCD, panic disorder, premenstrual dysphoric disorder, post-traumatic stress disorder and anxiety disorders, according to the Mayo Clinic.

But can you drink coffee with Zoloft, and are there any risks to taking sertraline and caffeine at the same time? Dr. Sullivan says that when it comes to Zoloft and caffeine, modest doses of the stimulant shouldn't cause any side effects.

However, if you're drinking large doses of caffeine with Zoloft, it's possible you may experience a Zoloft and coffee interaction like the serotonin syndrome described above.

As a result, your best bet for combining Zoloft and coffee is to stay under the expert-recommended limit of 400 milligrams of caffeine a day to avoid any sertraline and coffee issues.

Lexapro (escitalopram) is another SSRI used to treat depression, according to the Mayo Clinic.

But can you drink coffee or caffeine while on Lexapro? Like many other SSRIs, it's typically fine to combine Lexapro and caffeine, as long as you stick to lower doses, Dr. Sullivan says.

So while having a cup of coffee and Lexapro shouldn't be cause for concern, just remember that other sources of caffeine can contain higher doses of the stimulant. For instance, mixing Lexapro and energy drinks (rather than Lexapro and coffee) may overload you with caffeine and could lead to complications like serotonin syndrome.

And even if this doesn't cause complications related to your medication, drinking too much caffeine can lead to its own side effects, per the Mayo Clinic, including:

• Headache
• Insomnia
• Nervousness
• Irritability
• Frequent urination or inability to control urination
• Fast heartbeat
• Muscle tremors

Celexa (citalopram) is another common SSRI used to treat symptoms of depression, according to the Mayo Clinic.

There are no reported interactions between Celexa and caffeine, meaning you can likely safely take citalopram and caffeine together so long as you stick to appropriate doses of each.

Just make sure to avoid alcoholic beverages — you can't drink on citalopram, as the combination of medication and alcohol may cause unexpected side effects, per the Mayo Clinic.

Another common SSRI antidepressant is Prozac (fluoxetine), which is used to treat depression, OCD, eating disorders, premenstrual dysphoric disorder and panic attacks, according to the NLM.

Like most other SSRIs, taking fluoxetine and caffeine together shouldn't pose any issues — if you want to enjoy a cup of coffee with Prozac, that should be fine, Dr. Sullivan says, as there isn't evidence of any significant Prozac coffee or caffeine interactions.

Of course, just be sure to stick to modest doses of the stimulant if you're combining Prozac and coffee or caffeine, which will help you avoid complications like serotonin syndrome.

Serotonin and norepinephrine reuptake inhibitors, or SNRIs, are another common class of antidepressants. And there are also some SNRI and caffeine considerations to keep in mind.

The SNRI Effexor (venlafaxine), used to treat major depressive disorder and generalized anxiety disorder, can have side effects such as insomnia, nervousness and restlessness, per the NAMI.

Mixing Effexor and caffeine may worsen these issues, according to the NAMI.

So can you drink coffee with venlafaxine? Yes, you can drink small amounts of coffee while taking venlafaxine, Dr. Sullivan says — she just recommends being aware of the potential complications so that you can cut back on caffeine if any side effects occur.

Similarly, side effects like insomnia, anxiety, excitement and uncontrollable shaking are linked to Wellbutrin (bupropion), which is in a unique class of antidepressants, per the NLM.

This doesn't mean you have to rule out caffeine with these antidepressants, though. You can take steps to minimize side effects that may occur when combining Wellbutrin and caffeine.

"When I'm activating antidepressants like Effexor or Wellbutrin, I talk about sleep issues, about the need to generally take these meds in the morning and concerns about possible interactions with caffeine," Dr. Sullivan says.

Because whether you have a reaction or don't is unpredictable, Dr. Sullivan doesn't generally tell patients to cut back on caffeine in advance, only when side effects occur.

But it's important to be on the alert for them and to note how you feel when you drink or eat caffeine-rich beverages and foods, and remember that modest amounts of caffeine should be fine, according to Dr. Sullivan.

Cymbalta (duloxetine) belongs to a class of medicines called selective serotonin and norepinephrine reuptake inhibitors (SSNRIs), according to the Mayo Clinic. It's used to treat depression and anxiety, along with other conditions like fibromyalgia and diabetes-related nerve damage.

Though this type of medication can increase the activity of brain chemicals like serotonin, Cymbalta is not a stimulant that produces a jolt of energy in the same way caffeine does.

Typically, you can drink coffee while taking Cymbalta without any side effects, as there are no reported interactions between duloxetine and caffeine.

But if you do combine Cymbalta and caffeine or coffee, just make sure to stick to lower doses of the stimulant in order to avoid Cymbalta interactions like serotonin syndrome, Dr. Sullivan says.